Efectividad de la aplicación del programa Echomantra en una adolescente con anorexia nerviosa y su familiar: Un estudio de caso / Effectiveness of the application of the Echomantra in an adolescent girl with anorexia nervosa and her caregiver: A case study

El programa ECHOMANTRA tiene como finalidad facilitar la transición de las pacientes con un trastorno de la conducta alimentaria desde el ingreso hospitalario a su vida cotidiana. Consta de una intervención para los/las familiares (ECHO; Treasure et al., 2015) y otra para las pacientes (MANTRA, Schmidt, et al, 2014). El objetivo de este estudio fue evaluar la efectividad del programa ECHOMANTRA, aplicado junto al tratamiento usual, en una adolescente de 15 años con anorexia nerviosa (AN) y su madre. Se utilizó un diseño de caso único y medidas pre-post, con seguimiento a los 3 y 6 meses. En la paciente se evaluó: patología alimentaria (EDE-Q), estado emocional (DASS-21), ajuste psicosocial (EQ-5D-5L y el CIA 3.0) y motivación al cambio; y en la madre: emoción expresada (FQ), impacto de los síntomas (EDSIS), acomodación a la enfermedad (EAISA), estado emocional (DASS-21) y habilidades de cuidadora (CSS). Ambos programas constaban de 8 sesiones online individuales y semanales. Los resultados mostraron una reducción en la sintomatología de AN, aumento del IMC, mejora del estado emocional, motivación al cambio y ajuste psicosocial; y en la madre, mejoró el estado emocional y las habilidades de cuidado, y disminuyó la acomodación a la enfermedad, la emoción expresada y el impacto de los síntomas. Estos cambios se mantuvieron en el seguimiento. Ambas valoraron el programa como satisfactorio. La aceptabilidad y la eficiencia del tratamiento de la AN puede mejorarse utilizando el ECHOMANTRA para preparar la transición de la atención hospitalaria, apoyando a las pacientes y familiares. (AU)

The aim of the ECHOMANTRA program is to facilitate the transition from hospital back into the community. ECHOMANTRA is based on interventions for carers (Experienced Carers Helping Others, ECHO; Treasure et al. 2016) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA; Schmidt, et al., 2014). The aim of this study was to evaluate the effectiveness of the ECHOMANTRA program, applied together with the usual treatment, in a 15-yearold adolescent girl with anorexia nervosa (AN) and her mother. A single case design and pre-post measures were used, as well as follow-up at 3 and 6 months. The patient was assessed for: eating pathology (EDE-Q), emotional state (DASS-21), psychosocial adjustment (EQ-5D-5L and CIA 3.0) and motivation to change. In the mother: expressed emotion (FQ), symptom impact (EDSIS), accommodation to illness (EAISA), emotional state (DASS-21) and her caregiver skills (CSS) were assessed. Both programs consisted of 8 on-line sessions, which were conducted individually and on a weekly basis. The results showed a reduction in AN symptomatology, increased BMI, improved emotional state, motivation to change and psychosocial adjustment; and in the mother, improved emotional state and caregiving skills, and reduced accommodation to illness, expressed emotion and the impact of symptoms. These changes were maintained at follow-up. Both patient and family valued the program as satisfactory. Both the acceptability and efficiency of treatment for AN may be improved by using ECHOMANATRA to prepare for transition from inpatient care, by giving support to both patients and their carers. (AU)

Specificity and wealth of autobiographical memories in restrictive and mixed anorexic patients.

The reduced specificity of positive and negative autobiographical memories observed in anorexic (AN) patients may reflect a global disturbance in their emotional information processing. However, their emotional difficulties may differ according to the subtype of AN, implying possible differences in the manifestation of autobiographical memory impairments. The aims of the study were (1) to confirm the autobiographical memory deficits in AN patients in terms of specificity and wealth of memories, and (2) to compare autobiographical deficits according to the AN subtype: restrictive type (AR) or binge/purging type (AB). Ninety-five non-clinical (NC) individuals and 95 AN patients including 69 AR and 22 AB patients were administered the Williams' and Scott's Autobiographical Memory Test. The results confirmed a lack of specificity regardless of emotional valence in the overall AN patient group without any distinction of subtype, which was linked to the number of hospitalizations. When the AN subtype was considered, AR patients demonstrated reduced specificity for negative memories only, suggesting differences in emotional functioning or in the mechanisms underlying reduced specificity between AR and AB patients. Furthermore, the overall AN group demonstrated lower variability and complexity in their memory content than the NC group. However, this difference in the complexity of recalled memories was only found in response to negative cues. When AN subtypes were considered, AR patients showed fewer complex memories than NC individuals. Beyond a reduced specificity, AN patients also depict a poverty in the range of event recall and a difficulty in developing narrative content. The clinical implications of such autobiographical memory deficits need to be further investigated.

Emotional imagination of negative situations: Functional neuroimaging in anorexia and bulimia.

AIM: The present study aims to extend the knowledge of the neural correlates of emotion processing in first episode subjects affected by anorexia nervosa (AN) or bulimia nervosa (BN). We applied an emotional distress paradigm targeting negative emotions thought to be relevant for interpersonal difficulties and therapeutic resistance mechanisms. METHODS: The current study applied to 44 female participants with newly diagnosed AN or BN and 20 matched controls a neuroimaging paradigm eliciting affective responses. The measurements also included an extensive assessment comprising clinical scales, neuropsychological tests, measures of emotion processing and empathy. RESULTS: AN and BN did not differ from controls in terms of emotional response, emotion matching, self-reported empathy and cognitive performance. However, eating disorder and psychopathological clinical scores, as well as alexithymia levels, were increased in AN and BN. On a neural level, no significant group differences emerged, even when focusing on a region of interest selected a priori: the amygdala. Some interesting findings put in relation the hippocampal activity with the level of Body Dissatisfaction of the participants, the relative importance of the key nodes for the common network in the decoding of different emotions (BN = right amygdala, AN = anterior cingulate area), and the qualitative profile of the deactivations. CONCLUSIONS: Our data do not support the hypothesis that participants with AN or BN display reduced emotional responsiveness. However, peculiar characteristics in emotion processing could be associated to the three different groups. Therefore, relational difficulties in eating disorders, as well as therapeutic resistance, could be not secondary to a simple difficulty in feeling and identifying basic negative emotions in AN and BN participants.

Anorexia: a literature review of young people's experiences of hospital treatment.

Anorexia nervosa is characterised by significantly low body weight, a fear of weight gain and persistent efforts to prevent the restoration of normal weight. It has potentially life-threatening physical and psychological complications, and many young people with anorexia present to hospital in a seriously compromised physical condition. While their physical symptoms require urgent treatment, addressing their emotional and psychological needs is equally important if they are to progress towards recovery. However, the conflicting thoughts common in anorexia mean that young people often feel highly ambivalent about treatment, which makes the disorder particularly challenging to treat. This article details a literature review undertaken to explore the perceptions and experiences of young people who have received hospital treatment for anorexia, with the aim of offering children's nurses insights into how they can optimally support these patients. The findings demonstrate the importance of listening to young people, treating them as individuals and understanding their experiences, in addition to addressing their physical health needs.

A voracidade do supereu e a anorexia na adolescência / La voracidad del superyó y la anorexia en la adolescencia / The superego's voracity and the anorexia in adolescence / La voracité du surmoi dans l'anorexie à l'adolescence

Neste artigo, abordamos as implicações de um supereu voraz na anorexia durante a adolescência a partir da psicanálise lacaniana. Para tanto, evidenciamos a adolescência enquanto um marco no processo de subjetivação, que convoca um outro posicionamento em relação ao sexual e ao desejo. A anorexia pode aparecer como uma via de posicionamento do sujeito diante da questão do sexual. Nesse caso, a voz do supereu, convocada como uma reposta ao dilema adolescente, conduz o sujeito a uma armadilha na qual o gozo é resultado da renúncia. Seu alto preço se faz ver em um corpo devorado pela voracidade e tirania do supereu

En este artículo,abordamos las implicaciones de un superyó voraz para la anorexia durante la adolescencia a través del psicoanálisis lacaniano. Para ello, destacamos la adolescencia como un hito en el proceso de subjetivación, que reclama otra posición en relación a la sexualidad y el deseo. La anorexia puede aparecer como una forma de posicionar al sujeto frente a la cuestión sexual. En este caso, la voz del superyó convocada como respuesta al dilema adolescente conduce al sujeto a una trampa, en la que el goce es fruto de la renuncia y cuyo alto precio se ve en un cuerpo devorado por la voracidad y la tiranía del superyó

In this article, we approach the implications of a voracious superego for anorexia during adolescence through lacanian psychoanalysis. For this, we highlight adolescence as a milestone in the process of subjectivation, which calls for another position in relation to sexuality and desire. Anorexia can appear as a way of positioning the subject in the face of the sexual issue. In this case, the superego's voice summoned as a response to the adolescent dilemma leads the subject to a trap, in which the joy is the result of renunciation and whose high price is seen in a body devoured by the voracity and tyranny of the superego

Dans cet article, nous abordons les implications d'un surmoi vorace dans l'anorexie à l'adolescence du point de vue de la psychanalyse lacanienne. Ainsi, nous soulignons l'adolescence comme un jalon dans le processus de subjectivation, qui appelle un autre positionnement par rapport à la sexualité et au désir. L'anorexie peut apparaître comme un moyen de positionner le sujet par rapport à la problématique sexuelle. Dans ce cas, la voix du surmoi, convoquée en réponse au dilemme adolescent, entraîne le sujet dans un piège où la jouissance est le résultat du renoncement. Son prix élevé se voit dans un corps dévoré par la voracité et la tyrannie du surmoi

AgRP neurons control compulsive exercise and survival in an activity-based anorexia model.

Hypothalamic agouti-related peptide (AgRP) and neuropeptide Y-expressing neurons have a critical role in driving food intake, but also in modulating complex, non-feeding behaviours1. We interrogated whether AgRP neurons are relevant to the emergence of anorexia nervosa symptomatology in a mouse model. Here we show, using in vivo fibre photometry, a rapid inhibition of AgRP neuronal activity following voluntary cessation of running. All AgRP neuron-ablated, food-restricted mice die within 72 h of compulsive running, while daily activation of AgRP neurons using a chemogenetic tool increases voluntary running with no lethality of food-restricted animals. Animals with impaired AgRP neuronal circuits are unable to properly mobilize fuels during food-restriction-associated exercise; however, when provided with elevated fat content through diet, their death is completely prevented. Elevated fat content in the diet also prevents the long-term behavioural impact of food-restricted fit mice with elevated exercise volume. These observations elucidate a previously unsuspected organizational role of AgRP neurons, via the mediation of the periphery, in the regulation of compulsive exercise and its related lethality with possible implications for psychiatric conditions, such as anorexia nervosa.

Subhypnotic dose of intravenous propofol stimulates appetite in cats with stress-induced anorexia.

BACKGROUND: Stress-induced anorexia is common in cats. While medications are available to stimulate appetite, many require oral administration, have delayed onset-of-action or cause adverse side effects. The aim of this study was to determine whether cats diagnosed with stress-induced anorexia given a subhypnotic dose of intravenous propofol would have increased short-term appetite as compared to those given placebo. METHODS: Anorexic shelter cats received either 1 mg/kg propofol or 1 mL saline placebo and then presented with various commercial cat foods. Grams of food consumed was measured at 15 and 30 min, and total grams compared between treatment and control groups using the Wilcoxon rank-sum test. 12 cats were enrolled, with six cats randomly assigned to each group. RESULTS: The median amount consumed by the treatment group was 31 g (range: 0-72), with the median for the four cats (67 per cent) who consumed food being 45 g (range: 26-72), or 49 per cent of their daily maintenance calorie requirement. The median amount consumed by control cats was 0 g (range: 0-5), with one cat consuming food. Total grams consumed was different between treatment and control groups (P=0.05). CONCLUSION: A subhypnotic dose of intravenous propofol increased appetite in cats with stress-induced anorexia for a 30 min period.

Health-related quality of life in patients with fully resected BRAFV600 mutation-positive melanoma receiving adjuvant vemurafenib.

AIM OF STUDY: The aim of the study was to assess the impact of treatment with adjuvant vemurafenib monotherapy on health-related quality of life (HRQOL) in patients with resected stage IIC-IIIC melanoma. METHODS: The phase 3 BRIM8 study (NCT01667419) randomised patients with BRAFV600 mutation-positive resected stage IIC-IIIC melanoma to 960 mg of vemurafenib twice daily or matching placebo for 52 weeks (13 × 28-day cycles). Patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) version 3 at baseline, cycle 1 (days 1, 15 and 22), cycle 2 (days 1 and 15), day 1 of every subsequent 4-week cycle, the end-of-treatment visit and each visit during the follow-up period. RESULTS: Completion rates for the EORTC QLQ-C30 questionnaire were high (>80%). There was a mean decline in the global health status (GHS)/quality of life (QOL) score of 17.4 (±22.9) and 17.3 (±24.1) points at days 15 and 22 of cycle 1, respectively, among vemurafenib-treated patients who recovered to approximately 10 points below baseline for the remainder of the treatment period. A similar trend was observed in all functional scales except for cognitive function (<10-point change from baseline at all visits) and in the symptom scores for appetite loss, fatigue and pain. As observed for the GHS/QOL score, all scores rapidly returned to baseline after completion of planned vemurafenib treatment or treatment discontinuation. CONCLUSIONS: The schedule of HRQOL assessments allowed for an accurate and complete evaluation of the impact of acute treatment-related symptoms. Vemurafenib-treated patients experience clinically meaningful moderate worsening in some treatment- or disease-related symptoms and GHS/QOL that resolve over time.

How should the law determine capacity to refuse treatment for anorexia?

This article critically assesses the way a certain court has determined the capacity of a person diagnosed with anorexia to refuse medical treatment. It is shown that when making this determination, the court has adopted a process of circular reasoning, meaning anyone with the diagnosis will be found to lack capacity to refuse its treatment. This circular reasoning means that indicia of capacity that ought to be considered by the court is ignored. The result is a procedure in which the anorexic patient has no voice, and an outcome against which he or she has no effective legal recourse. This problem, it is argued, can be overcome in two ways. Firstly, courts must make sure that the 'functional' test of capacity is properly applied, meaning any finding of incapacity must rest on evidenced deficits in decision-making ability. Secondly, courts must properly engage with the subjective reasoning of the person making the treatment refusal.

Activation of orexinergic and histaminergic pathway involved in therapeutic effect of histamine H4 receptor antagonist against cisplatin-induced anorexia in mice.

We previously reported that hypothalamic tumor necrosis factor-alpha (TNF-α) mRNA expression via histamine H4 receptors contributes to the development of cisplatin-induced anorexia; however, its precise mechanisms remain unclear. It has been reported that chemotherapeutic agents induce the suppression of orexin neuron activity, and the administration of orexin inhibits chemotherapeutic agent-induced gastric discomfort. Other studies demonstrated that the central administration of TNF-α impairs the orexinergic system, and that orexin excites the histaminergic system. We investigated the involvement of orexinergic and histaminergic systems in the therapeutic effect of an H4 receptor antagonist against cisplatin-induced anorexia. Cisplatin decreased the expression of prepro-orexin mRNA, which encodes precursors of orexin, in the hypothalamus of mice. The period of expression decreased in parallel with the onset of anorexia, and treatment with an H4 receptor antagonist (JNJ7777120, 10 mg/kg) inhibited the decrease in expression. The effect of the H4 receptor antagonist on cisplatin-induced anorexia in mice was antagonized by an orexin OX2 receptor antagonist (JNJ10397049, 5 mg/kg) rather than an orexin OX1 receptor antagonist (SB408124, 30 mg/kg). Although an OX2 receptor agonist (YNT-185, 20 mg/kg) or a histamine H3 receptor inverse agonist (ciproxifan, 1 mg/kg) inhibited the cisplatin-induced anorexia, the inhibitory effect of the OX2 receptor agonist was antagonized by an H3 receptor silent antagonist (VUF5681, 5 mg/kg). The combination of JNJ7777120 (10 mg/kg) and ciproxifan (0.5 mg/kg) completely resolved the cisplatin-induced anorexia. These results suggest that activation of the orexinergic and histaminergic pathway is involved in the therapeutic effect of an H4 receptor antagonist against cisplatin-induced anorexia.

Behavioral assessment of activity-based-anorexia: how cognition can become the drive wheel.

Anorexia Nervosa (AN) is a disorder with a dramatic impact on both the individual and society. Besides severe weight loss, excessive physical exercise and cognitive disturbances can be present in patients with AN as primary symptoms of the pathology or as secondary effects induced by physical and metabolic alterations. Mechanistic research in this field has taken advantage of a well characterized animal model, the activity-based anorexia model (ABA). ABA rodents and subjects with AN show clear behavioral and physiological similarities, but a throughout neurocognitive assessment of the model is still missing. Here, we review the available literature in the ABA field, highlighting similarities between ABA and AN at the behavioral, neurophysiological and cognitive level. Furthermore, based on availability, feasibility and adaptability of rodent behavioral protocols, we propose a set of neurocognitive assays that can be performed on the ABA. The proposed assessment represents an important step forward in the validation and extension of the ABA model, opening several routes of investigation related to AN and other eating disorders.

Endocannabinoid regulation of homeostatic feeding and stress-induced alterations in food intake in male rats.

BACKGROUND AND PURPOSE: Stress is known to reduce food intake. Many aspects of the stress response and feeding are regulated by the endocannabinoid system, but the roles of anandamide (AEA) and 2-arachidonoyl glycerol (2-AG) in stress-induced anorexia are unclear. EXPERIMENTAL APPROACH: Effects of acute restraint stress on endocannabinoids were investigated in male Sprague-Dawley rats. Systemic and central pharmacological inhibition of fatty acid amide hydrolase (FAAH) or monoacylglycerol lipase (MAGL) was used to assess the effects of elevated AEA and 2-AG on homeostatic feeding and on food consumption after stress. Animals were pretreated with the FAAH inhibitor, PF-04457845, or the MAGL inhibitor, MJN110, before 2 h acute restraint stress or 2 h homecage period without food. KEY RESULTS: Restraint stress decreased hypothalamic and circulating AEA, with no effect in the gastrointestinal tract, while 2-AG content in the jejunum (but not duodenum) was reduced. PF-04457845 (30 µg), given i.c.v., attenuated stress-induced anorexia via CB1 receptors, but reduced homeostatic feeding in unstressed animals through an unknown mechanism. On the other hand, systemic administration of MJN110 (10 mg·kg-1 ) reduced feeding, regardless of stress or feeding status and inhibited basal intestinal transit in unstressed rats. The ability of MAGL inhibition to reduce feeding in combination with stress was independent of CB1 receptor signalling in the gut as the peripherally restricted CB1 receptor antagonist, AM6545 did not block this effect. CONCLUSIONS AND IMPLICATIONS: Our data reveal diverse roles for 2-AG and AEA in homeostatic feeding and changes in energy intake following stress. LINKED ARTICLES: This article is part of a themed section on 8th European Workshop on Cannabinoid Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.10/issuetoc.

"It's the Symptom of the Problem, Not the Problem itself": A Qualitative Exploration of the Role of Pro-anorexia Websites in Users' Disordered Eating.

The growing trend in the use of the Internet and social media as a method of self-managing illness presents a critical opportunity to better understand the role of pro-anorexia (pro-ana) websites for eating disorders. Therefore, 155 pro-ana website messages regarding criticism that the site was responsible for developing anorexia were inductively thematically analysed. The analysis revealed five main themes: eating disorders are mental illnesses and websites do not cause mental illness, pro-ana websites and eating disorders are more than wanting to be thin (with sub-theme residents and visitors), eating disorders develop regardless of pro-ana websites, pro-ana sites do not cause eating disorders but they may trigger or encourage them (with sub-theme the problem is the user, not the site) and pro-ana sites provide support. Pro-ana websites and online communities present clinicians with complex treatment challenges. Collaborative, therapeutic consultations about pro-ana website use may help to establish how and when accessing them may hinder the treatment process.

Losing Health Symbols Because of Nutrition-Related Problems in Advanced Cancer: An Interpretative Phenomenological Analysis.

Cancer and nutrition-related problems are extremely distressing events and disturb functioning and daily life. It is recognized that the effects of stressors challenging well-being are mediated by the meaning attached to these stressors. As nutrition-related problems are often being experienced within couples, it is also important to gain understanding of a partner's interpretation of complaints and whether it coincides with that of the patient.To explore the meaning attached to nutrition-related problems, a qualitative approach was followed. Seven couples, each composed of a patient with cancer and his/her cohabiting life partner, participated. Data were collected through in-depth interviews and analyzed by an interpretative phenomenological approach.Nutrition-related problems among patients with advanced cancer are mostly perceived as destroying health and leading to loss of physical, psychological, and social health symbols. Because the meaning patients and their partners attach to nutrition-related problems is individual and dynamic, it is necessary to devote special attention to the issues on different occasions.The study findings can assist nurses and other professional caregivers in providing psychological support for couples confronted with nutrition-related problems in advanced cancer. It is important to take into account the meaning patients and partners attach to these nutrition-related problems.

"Meu nome é Ana" - um estudo fenomenológico-existencial da experiência de mulheres com anorexia nervosa / "Hi, my name is Ana" - a women's experience existential-phenomenological study with nervosa anorexia / "Hola, mi nombre es Ana" - un estudio de las mujeres experimentan fenomenológico-existencial con anorexia nervosa

A pesquisa teve como objetivo compreender, a partir de um olhar fenomenológico-existencial heideggeriano, a experiência de anorexia. Foram utilizadas entrevistas semiestruturadas como meio de acesso à experiência. Foram entrevistadas duas pessoas do sexo feminino, com idades de 17 e 30 anos. A entrevista iniciava-se com uma pergunta disparadora: "Como foi, ou como é, a sua experiência de anorexia?", que permitiu às entrevistadas falarem sobre as suas experiências. O diário de campo também foi utilizado como recurso metodológico, buscando uma maior aproximação das experiências das entrevistadas e da pesquisadora. As entrevistas e o diário de campo foram interpretados à luz da hermenêutica heideggeriana. Os sentidos que apareceram nas narrativas desvelaram questões para além do corpo físico e da patologia, estando envolvidos família, desejos, amigos, experiências, projetos de vida. Dentre as ideias heideggerianas ressaltadas, estão o cuidado, inospitalidade, habitar, abertura às possibilidades e facticidade, que puderam ser discutidos na interpretação, gerando reflexões acerca dos sentidos da experiência de anorexia nervosa na existência das entrevistadas.

This research's objective was to understand, from an existential-phenomenological perspective, anorexia experience. Semi-structured interviews were used as a means of access to the experience. Female two people were interviewed, at the age of 17 and 30. The interview begins with a starter question, "How was, or how, their anorexia experience?", which allowed the interviewee to talk about their experience. The field diary was also used as a methodological resource, seeking a greater approximation of the experiences of the interviewees and the researcher. The interviews and the field diary were interpreted by Heidegger's hermeneutics. The senses unveiled in the narratives revealed issues beyond the physical and pathological issue, being involved family, wishes, friends, experiences, life projects. Among the Heideggerian ideas highlighted are careful, inhospitality, to dwell, openness the possibilities and factuality, which could be discussed in the interpretation, generating reflections on the meanings of anorexia nervosa experience in the existence of the interviewees.

La investigación tuvo como objetivo comprender, desde una mirada existencial-fenomenológica de Heidegger, la experiencia de la anorexia. Fueron utilizadas entrevistas semiestruturadas como medio de acceso a la experiencia. Fueron entrevistadas dos personas del sexo femenino, con edades de 17 y 30 años. La entrevista comienza con una pregunta de arranque (¿Cómo fue o es su experiencia de la anorexia?"), permitiendo la entrevistada habla de su experiencia. El diario de campo también fué utilizado como recurso metodologico, buscando una mayor aproximación de las experiencias de los entrevistados y el investigador. Las entrevistas y el diario de campo fueron interpretados a la luz de la hermenéutica de Heidegger. Los sentidos que aparecen en los relatos revelan temas más allá del cuerpo físico y la patología, siendo tambén implicado la familia, los amigos, deseos, experiencias, proyectos de vida. Entre las ideas de Heidegger, hay énfasis al cuidado, inhospitalidad, la apertura de las posibilidades y facticidad, discutidos en la interpretación, promoviendo reflexiones sobre sus sentidos y su existencia.

Not Eating or Tasting Other Ways to Live: A Qualitative Analysis of 'Living Through' and Desiring to Maintain Anorexia.

Whilst recent discussions of anorexia nervosa have recognised key aspects of the illness experience, such as control and emotion regulation, there remains a cross-disciplinary emphasis on body image concerns as central. In dialogue with clinical, psychological and social analyses, this paper draws on ethnography and qualitative interviews with individuals diagnosed with anorexia to offer an alternative perspective. Focusing on individuals' engagements with food and (not) eating suggests that material moments of starving, calorie counting, and thinking about food provide a critical lens onto what anorexia does for, as well as to, individuals living with the illness. Participants' narratives suggest that anorexia can make it possible to retreat into a numb and protective 'bubble.' The illness may thereby offer a way to be in the world that both responds to and ameliorates distress; some individuals describe the ambivalent 'safety' of living through their anorexia. As such, food practices are a modality of holding onto anorexia's valued safety. By outlining this relationship between practices of (not) eating and a desire amongst some individuals to maintain the illness, this paper contributes to discussions of treatment resistance. Intersecting with wider reflections on trauma, recovery and harm minimisation in mental health, the discussion considers how this desire might be approached ethically in both research and therapeutic practice. Individuals' narratives suggest the need to reposition attention away from anorexia itself to the distress and traumatic life events that may underlie both the illness and the desire to maintain it.

Quality of life and anorexia/cachexia in lung cancer: validation of the Spanish version of the FAACT instrument.

PURPOSE: The cancer anorexia-cachexia syndrome (CACS) is highly prevalent in lung cancer (LC) patients (57-61%), and represents the direct cause of death in 20% of cases. Accurately quantifying CACS has been a challenging issue; consequently, this study presents the clinical validation of the Spanish version of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in LC patients from Latin America. METHODS: The Spanish version of the FAACT and the Mexican-Spanish version of the EORTC-QLQ-C30 instruments were applied to a cohort of patients with LC at the National Cancer Institute of Mexico. Reliability and validity tests were performed to assess the psychometric properties of the scales, and clinical validation was assessed considering the association of scales with subjective and objective clinical data. RESULTS: Two hundred patients were included. Questionnaire compliance rates were high (100%) and the instrument was well accepted in all cases; internal consistency tests demonstrated good convergent and divergent validity of the scale structure. Cronbach's α coefficient for three out of five basic multi-item scales was > 0.7 (0.55-0.86). FAACT scales presented significant associations with clinical parameters, including biochemical and nutritional variables (i.e., energy intake, p = 0.002), as well as strongly correlated with the appetite loss subscale of the QLQ-C30 questionnaire (r = - 0.624). Physical well-being (p < 0.0009), functional well-being (p = 0.004), anorexia/cachexia scale (p = 0.029), and FAACT total scores (p = 0.0009) were strongly associated to overall survival. CONCLUSION: The Spanish version of the FAACT questionnaire is reliable and valid for the assessment of health-related quality of life and CACS in LC patients and can be used in clinical trials.

Early postoperative undernutrition following aortic valve replacement surgery.

BACKGROUND: Experiencing loss of appetite after cardiac surgery is often noted during daily care and has been described by several studies. However, no information is available on either energy needs or spontaneous food intake following aortic valve replacement surgery. The goal of this study was to assess the risk of early postoperative undernutrition following aortic valve replacement in a group of patients who were preoperatively well-nourished. METHODS: Anthropometrics data (body mass index, fat free mass index, albuminemia and prealbuminemia, extracellular water), energy balance and appetite were assessed in a cross-over prospective observational study. . Each subject was enrolled in two procedures: surgery and routine coronary angiograms which were used for control matched assessment. Data were assessed during the pre-procedure period (d-15 to d-1) and the post-procedure period (d0 to d+4). Energy expenditure was determined by indirect calorimetry. RESULTS: 15 patients median aged 73 years old [65-77] were included in the study. In post-surgery period, weight and extracellular water were increased and correlated (r2 = 0.571, p = 0.003). CRP was increased from 2 [2;3] to 91 [73;138] (p = 0.001). Ingested calories decreased from 1451 [1272-1640] kcal to 372 [22-528] kcal (p = 0.001) while energy expenditure was increased from 1358 [1180-1559] kcal to 1613 [1472-1670] kcal (p = 0.002). A severe loss of appetite was noted (p = 0.011). None of these changes were observed in the control phase. CONCLUSION: Energy balance was strongly negative after cardiac surgery. Cardiac surgery increased endogenous metabolism by 20% and a severe loss of appetite decrease food intake by 75%, which does not make it possible to compensate for the increase in resting energy expenditure.